Provider Demographics
NPI:1265501001
Name:ROETERING, CAROLYN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:ROETERING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 GOLF CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8224
Mailing Address - Country:US
Mailing Address - Phone:513-893-1100
Mailing Address - Fax:513-893-1128
Practice Address - Street 1:5964 GOLF CLUB LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8224
Practice Address - Country:US
Practice Address - Phone:513-893-1100
Practice Address - Fax:513-893-1128
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD919617-01OtherBC/BS
MDS062-0321OtherBC/BS REGIONAL
MDS062-0321OtherBC/BS REGIONAL